Abstract
PurposeTo determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency.MethodsIn a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation.ResultsLaparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift.ConclusionWhen CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.
Highlights
Hysteroscopy is known as the gold standard for intrauterine evaluation [1, 2] and can routinely be performed in office settings [2,3,4]
The Parryscope was shown superior to the Flow method [8] and achieved high overall accuracy [8, 9], use of sonography to detect posthysteroscopy shifts of cul de sac (CDS) fluid was previously described for supplementing the Parryscope technique [9]
We considered the presence of a sonographic fluid shift in Douglas pouch before and after the hysteroscopy to be the main outcome parameter
Summary
Hysteroscopy is known as the gold standard for intrauterine evaluation [1, 2] and can routinely be performed in office settings [2,3,4]. Two of them were evaluated in a recent randomized controlled trial by our group [8]–the Parryscope technique where air bubbles are introduced into the uterine cavity and are observed whether they traverse the tubal ostia, [2, 7,8,9] and the Flow technique. The Parryscope was shown superior to the Flow method [8] and achieved high overall accuracy [8, 9], use of sonography to detect posthysteroscopy shifts of cul de sac (CDS) fluid was previously described for supplementing the Parryscope technique [9]. Peregrin-Alvarez et al conducted a prospective observational study, wherein they claimed that all women
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